Nurses not doing assessments
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I am RN with 6 years experience and never have I seen anything like this. I am a new employee at a hospital in California with majority of the nurses are Filipino. I was on orientation and I had 4... Read More

May 31, '07

O K........no degree debate AND no "color" debate. This should go without saying, but let's not get this thread closed due to the above. OK???????Be nice.

Seems to me she asked because she wished to know if the practices taught to Filipino nurses who take their education IN the Philippines, rather than Filipino nurse who take their education in the U.S., differed in substance. It was a fair question, but of course there is ALWAYS someone who wants to throw out the "race" or "stereotype" card right away. Congrats.

Er, she made it an issue by stating that the reason she was questioning the education system in the Phillipines was because of 4-FOUR-nurses that she worked with that allegedly didn't do assessments. She admitted that she had worked with Filipino nurses who DID do assessments but because she ran into 4 who did not, then the entire educational system is to be questioned? It was absolutely not fair, NOT fair at all. And I'm sorry that you and P_RN got so nervous because of my analogy but I was trying to make a point which you very deftly missed. Congrats yourself.

May 31, '07

Not at all nervous, just want to keep the flow mellow and smooth. The "issue" has been resolved now. Many times people mis-speak when they address a forum. Please make allowances.

May 31, '07

Okay, enough with the Filipino thing. I don't care if they were from Canada, USA, Egypt, or Mars. This is a very good thread! It's not a race issue, it's a patient safety issue. Pretend she never said the "F" word (haha) and let's talk about the real issue - nursing assessments!

Kul - not sure exactly what you mean since the quote thing didn't work right, but I'll give it a shot:
[quote=KulRN;2228174]

I'm not quite sure what you meant by this....but I too chart a lot but I only chart what I saw, heard and what I did....and it all depends on the situation too....I try to do my rounds every 2 hours and sometime more often depending on my patient's status...and I document...and at the end of my shift I report everything..there were few occassions where the previous nurse documented a wound as a pressure ulcer and finding out during my FULL ASSESMENT (patient report) that it was a wound not related to a pressure ulcer...and yeah, the other day night RN reported to me that the patient had an HL to her left A/C and when I asked the patient where it was...patient said "they never put one in" (this patient is A/O)....

Our assessment flowseet has spaces for the hours across the top, and the assessment along the side. For example, for evening shift, I would put say, 1600 as my initial assessment time and fill out the boxes (apical reg, resps reg/unlabored, clear to auscultation, on room air, denies pain, has a foley and an NG etc etc). After that, each 2 hours, I go back and reassess - not a full assessment, just that resps are still reg/unlabored, still on room air, still has foley, etc. I would do that at 18, 20, and 22. The nurse I am talking about does that at the beginning of the shift. So even though it is only 1600, she has already charted all of her 2200 information. If something changes - say the pt passes away at 1800, it's going to look pretty bad if her charting says that the resps are regular (or irregular, or labored, or whatever) at 2200. Does that make more sense? Charting without doing? Falsifying charting? I guess I would just call it "charing in advance", which, of course, is a . I know this is long-winded - I just hope it makes sense!!!

In the UK we are not taught to listen to routinely heart and lung sounds, I have only learnt during my Nurse Practitioner MSC, usually this level of examination is something medics or nurse practitioners do. Nurses do assess patients but in differently to how it sounds you do in the US.

Same in Australia. The only time I have seen nurses routinely assess heart and lung sounds is in ICU. I had a patient recently who became acutely SOB and desatted from 97% to 92% within 15 minutes (while 92% isn't awfully scary, the quick drop bothered me) and the doc was really taken aback that I had grabbed a steth and had a quick listen to the chest to see if there was anything weird going on. Otherwise we only have stethoscopes around to do manual BPs.

May 31, '07

Post# 26 gucci rush stated that "wondering if assessment were taught in their country. I also work with other filipino nurses who are very thorough and do their job well." Again, in post# 1, gucci rush stated that "My question is in other countries are they taught different because we all know here in the U.S. that assessing your patient is the first thing you are taught to do in school."
It is very interesting to see that gucci rush brought out the argument and then she gave the contradictory answer to her owe argument.
If that wasn't what other countries have taught, then how come some of gucci rush's coworkers did their job well as stated in post# 26. Apparently, they were taught about what to do. Otherwise, gucci rush has to change the original statement. It is very important not to attack your own argument, as I was taught in English 101.
Anyhow, I think it is not only one specific group of people who are doing it. Black, white, Asian and Latino nurses are doing the same thing. Whether they graduated from colleges in other countries or colleges in our own backyard. I think the problem is caused by some other problems rather than they were taught in school or not.

May 31, '07

i dont understand how aussie and uk nurses arent taught to routinely assess heart and lung sounds!?!. How do you protect the pt as we all your own self if the pts condition deteriorates...what baseline would you have then? How would you know if the lung sounds are clear upon auscultation or if there are crackles...or if their heart sounds suddenly are abnormal?

May 31, '07

Let's post that query in the Aussie and UK forums and see if it is a country wide or just individual university policy.

post# 26 gucci rush stated that "wondering if assessment were taught in their country. i also work with other filipino nurses who are very thorough and do their job well." again, in post# 1, gucci rush stated that "my question is in other countries are they taught different because we all know here in the u.s. that assessing your patient is the first thing you are taught to do in school."
it is very interesting to see that gucci rush brought out the argument and then she gave the contradictory answer to her owe argument.
if that wasn't what other countries have taught, then how come some of gucci rush's coworkers did their job well as stated in post# 26. apparently, they were taught about what to do. otherwise, gucci rush has to change the original statement. it is very important not to attack your own argument, as i was taught in english 101.

sorry, but i have to disagree that those statements were contradictory.

[color=#483d8b]just because a nurse is filipino in ethinicity doesn't mean he/she was educated in the phillipines. many foreign nurses are educated here. i went to school with a girl who was native to south korea, but she went to nursing school here in the us.

[color=#483d8b]it is also possible that a phillipine-educated nurse, not originally taught to assess closely, was precepted here and taught otherwise once working in the us.

[color=#483d8b]i'm not necessarily saying the above is true, i'm just saying that it is possible, and the op's questions wasn't unreasonable.

[color=#483d8b]however, i think i remember reading in the thread about the child that died from a kcl injection that it isn't common for nurses in the phillipines to assess as we do.
[color=#483d8b]see thread http://allnurses.com/forums/f195/bab...-213325-9.html , esp post #19. maybe i misunderstood, but i took that to mean that in their country, they arn't responsible for assessments the same way we are in the us.

[color=#483d8b]i've worked with several nurses from the phillipines, and they have all been excellent, hard working, and very good with their assessment skills. i've had no problems or issues.

our assessment flowseet has spaces for the hours across the top, and the assessment along the side. for example, for evening shift, i would put say, 1600 as my initial assessment time and fill out the boxes (apical reg, resps reg/unlabored, clear to auscultation, on room air, denies pain, has a foley and an ng etc etc). after that, each 2 hours, i go back and reassess - not a full assessment, just that resps are still reg/unlabored, still on room air, still has foley, etc. i would do that at 18, 20, and 22. the nurse i am talking about does that at the beginning of the shift. so even though it is only 1600, she has already charted all of her 2200 information. if something changes - say the pt passes away at 1800, it's going to look pretty bad if her charting says that the resps are regular (or irregular, or labored, or whatever) at 2200. does that make more sense? charting without doing? falsifying charting? i guess i would just call it "charing in advance", which, of course, is a . i know this is long-winded - i just hope it makes sense!!!

i've seen the same thing. one icu i worked in, we had to assess our vents qhr, and vs somewhere between q15 min-q2hrs, depending on acuity. our basic assessment had to be done either qhr or q2hrs (at least on the flowsheet; sometimes patient condition would require more frequent assessments, but there was only space on the flow sheet for hourly monitoring. anything more frequent had to go in narrative form).

[color=#483d8b]we had one nurse who would fill out the entire flow sheet -- complete with assessments, turns, vital signs, vent settings (including spontaneous tidal volume, peak pressures) baths, etc -- the whole thing -- at the begining of her shift. i found this one night when she was pretty busy and i was trying to help her out by doing one of her vent/vs/uop checks, and found the whole blessed flow sheet filled out until 6am. i think it was about 10pm at the time. came to find out that this wasn't an unusual occurance for her. she was also known for checking meds out of the pyxis (that wern't ordered) and not charting them. but, in report, she'd tell you "i couldn't get them to calm down for anything! threw the whole pyxis at them, but they still thrashed about!" needless to say, she doesn't work there anymore. (well, neither do i; but we left for entirely different reasons. i'm eligible for rehire).

[color=#483d8b]at any rate, thorough assessment is a standard of care in the us, and any nurse that isn't doing an assessment based off of their scope of practice isn't providing acceptable care, regardless of their country of education. however, i'm afraid that it happens more often than anyone cares to admit. blame it on burn-out, blame it on high nurse to patient ratios, blame it on lack of education; it doesn't matter what you blame it on, it is still unethical in this country.

i dont understand how aussie and uk nurses arent taught to routinely assess heart and lung sounds!?!. How do you protect the pt as we all your own self if the pts condition deteriorates...what baseline would you have then? How would you know if the lung sounds are clear upon auscultation or if there are crackles...or if their heart sounds suddenly are abnormal?

I have posted a response in the UK section but thought I would answer it here as well. I think that nursing in the Uk is very different to nursing in the US. I have worked in many different areas within the UK and have also taught nursing students as a nurse lecturer (many years ago).

As far a I know the clinical examination skills are not routinely part of the nurse education system.

I am now a NP so I do listen and have been taught examination skills but before I did my NPs MSc if I had a patient who had a deteriorating respiratory status I used other observations, looking at your patient, do thye look distressed, short of breath etc, respiratory rate, O2 sats, other CVS observations, if I was worried then I would get a medic to review the patient.

To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different

Jun 1, '07

To be honest I really don't know where UK nurses would find the time to do a full examination of all their patients, but that does not mean they do not assess thier patients. I suppose our assessments are just different

I'm curious about this. In my job, most of my time is spent on assessments, reassessments after interventions, etc. What do UK nurses do that don't allow them to have time for full examinations? (seriously, I'm not trying to be derogatory; I'm interested to know how the UK is different)